摘要
目的探讨体外心脏震波系统(CSWT)治疗顽固性心绞痛的有效性和安全性。方法选取15例经多种治疗仍有心绞痛的冠心病患者。结合心肌核素显像和冠状动脉造影结果确定缺血心肌靶目标。CSWT疗程为3个月,共治疗9次。临床效果评价选用加拿大心血管学会心绞痛分级(CCS)、6 min步行试验、纽约心功能分级(NYHA)、西雅图心绞痛量表(SAQ)和硝酸甘油使用量、左心室舒张末期直径(LVEDD)和左心室射血分数(LVEF)等指标进行评估。比较治疗前后心肌血流灌注评分和缺血面积来评价缺血改善情况,并比较室壁运动幅度和增厚率来评价局部室壁功能。结果入选患者的CCS分级、NYHA分级、SAQ量表和硝酸甘油使用量均有显著改善,LVEDD略有增加而LVEF有所改善,但差异均无统计学意义(均为P>0.05)。治疗节段心肌核素静息评分和负荷评分分别由治疗前的1.89±0.94和2.56±1.19降至治疗后的1.37±1.07(P=0.004)和1.70±1.27(P=0.000);单位治疗节段心肌静息缺血面积和负荷缺血面积分别由30.81%±36.60%和61.85%±30.89%降为17.19%±28.34%(P=0.004)和46.31%±35.72%(P=0.001);静息室壁运动幅度和增厚率分别由(6.48±2.71)mm和44.00%±22.66%升至(7.49±2.43)mm(P=0.007)和50.46%±19.91%(P=0.038);负荷室壁运动幅度和增厚率分别由(6.50±2.46)mm和41.15%±18.92%变为(6.20±2.53)mm(P=0.318)和43.00%±24.72%(P=0.416)。患者治疗中未观察到不适症状;心电监测、血压和氧饱和度监测无明显变化;治疗后肌酸激酶、肌酸激酶同工酶MB、肌钙蛋白T未见升高,提示无心肌损伤。结论我们的研究提示,对于顽固性心绞痛患者,CSWT是一种有效、安全的治疗方法。
Objective To evaluate the efficacy and safety of extracorporeal cardiac shock wave system （ CSWT ） in treating refractory angina pectoris patients. Methods Fifteen patients with severe coronary artery disease which was documented by coronary angiogram present with refractory angina pectoris were selected. The ischemic area was determined by the 99m Technetium-MIBI single-photon emission computed tomography （SPECT）. The CSWT were performed in 3 months, and totally 9 times. The clinical evaluations include Canadian Cardiovascular Society （ CCS） class scores, New York Heart Association class （ NYHA ） , Seattle angina questionnaire （ SAQ ） , 6-min walking distance and the use of dosage of nitroglycerin;left ventricular end diastolic diameter （ LVEDD ） and left ventricular ejection of fraction （ LVEF） were also evaluated by echocardiography. The amelioration of ischemic myocardial was analyzed by SPECT, through comparison of myocardial perfusion scores and ischemic area before and after treatment. The variation of segment myocardial dysfunction was assessed by wall motion and wall thickening. Results CSWT obviously ameliorated CCS, NYHA, SAQ score, improved 6-min walking distance and decreased the use of nitroglycerin dose, but there was no significant changes in LVEDD and LVEF. SPECT date showed that in the treated segment, the rest myocardial perfusion score decreased from 1. 89 ± 0. 94 to 1. 37 ± 1. 07 （p=0. 004） and stress perfusion score also decreased from 2. 56 ±1. 19 to 1. 70 ±1. 27 （p=0. 000）. The rest ischemic area decreased from 30. 81% ± 36. 60% to 17. 19% ± 28. 34% （ p =0. 004 ） and stress ischemic area from 61. 85% ± 30. 89% to 46. 31% ± 35. 72% （ p=0. 001 ） . The ventricular wall motion was improved from （6. 48 ± 2. 71） mm to （7. 49 ± 2. 43） mm （p=0. 007） and thickening from 44. 00% ± 22. 66% to 50. 46% ± 19. 91% （p=0. 038） in the rest, but no significant changes in the stress. There was no significant changes in CK, CKMB, TNT and t
出处
《中国心血管杂志》
2015年第1期23-28,共6页
Chinese Journal of Cardiovascular Medicine
基金
首都市民健康项目培育(Z131100004013032)
关键词
冠状动脉疾病
心绞痛
体外心脏震波
放射性核素显像
Coronary artery disease
Angina pectoris
Extracorporeal cardiac shock wave
Radionuclide imaging
